Mark Edward Sissell

Primary specialty

Foster Care AgencyTaxonomy code 253J00000X

License

AL410007118 Issued in MI

Practice address

8180 19 Mile Rd
Sand Lake, MI 49343-9455

Phone

(616) 696-2304

Fax

(616) 696-1713

NPI assigned

Aug 12, 2019

Last updated

Aug 12, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1972159440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8180 19 MILE RD",
            "city": "SAND LAKE",
            "state": "MI",
            "postal_code": "493439455",
            "telephone_number": "616-696-2304",
            "fax_number": "616-696-1713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8180 19 MILE RD",
            "city": "SAND LAKE",
            "state": "MI",
            "postal_code": "493439455",
            "telephone_number": "616-696-2304",
            "fax_number": "616-696-1713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISSELL",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "MI",
            "license": "AL410007118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msissell@hotmail.com",
            "affiliation": "N",
            "address_1": "8180 19 Mile Rd",
            "city": "Sand Lake",
            "state": "MI",
            "country_code": "US",
            "postal_code": "493439455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Foster Care Agency in Sand Lake, MI
• Providers in Sand Lake, MI by specialty
• Foster Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.